Page 78 - Veterinary Laser Therapy in Small Animal Practice

64 Veterinary Laser Therapy in Small Animal Practice

We have three basic scenarios when we recheck a
chronic wound.

• The tissue looks the same: in this case, you
may either repeat the treatment and wait
another 24–48 h, or consider increasing the
dose and/or power density. You may be dealing
with a weak reactor, a patient that shows a
weak biological response to a standard dose or
treatment regime. You can see an example in (a)
clinical Case no. 2 at the end of this chapter.
Consider treating blood supply area.
• The tissue looks metabolically healthier: you
can repeat the same treatment parameters, as
in Case no. 7.
• The tissue looks more active, but a bit too
exuberant: this is actually a good sign for
a wound; it means you are dealing with a
strong reactor, but use half the dose and half
the power that you used the first day (see
case study no. 6). In many devices this means
switching from “chronic wound” settings to (b)
“acute wound” settings. Also give the patient
some time before the next appointment (e.g.
2–3 days instead of 24 h). In all cases, I am
talking exclusively about dogs and cats: other
species may have a different type of tissue
response, and the exuberant granulation may
require a different approach.

7.2.3 Burns (c)

As with any other type of wound, the benefits of help- Figure 7.5 (a) Second-degree burns in a puppy. This is a
ing burns heal with LT will include faster healing, typical example in which power density should be decreased
decreased pain, and decreased risk of infection. [187] due to hyperalgesia and decreased tolerance by the patient
Experimentally, LT can increase the number of intact – only 0.2 W/cm was used in this case, with 2 J/cm . (b) A
2
2
mast cells in the tissue during the early phases of burn week later, the same patient could now tolerate 1 W/cm of
2
healing, but decrease them in the remodeling phase. power density. (c) Ten more days and the threshold is now
2
[61] The qualitative improvement in the new tissue normal, with no signs of discomfort at 2–3 W/cm .
formed can have a great impact on the quality of life
of these animals, both because the new tissue will have This means decreasing power density, increasing hand
more organized collagen and greater tensile strength, speed, etc.
and because the increased malleability and decreased
inflammation will make chronic pain and central sensi- 7.2.4 Wound care, dressings, and laser therapy
tization less likely.
Nevertheless, this is probably the type of patient in If you wonder what LT has to do with wound dressings,
which you will have to take measures to decrease power let me ask you a couple of questions.
density and thermal accumulation, since hyperalgesia
and allodynia are common (Fig. 7.5) – see section 7.1, • Do you think that once you have a laser, wound care
“General treatment considerations and parameters.” will actually matter? After all, with such an amazing

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